Center for Epidemiological Studies and Clinical Trials, and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Hypertens. 2010 Oct;28(10):2036-45. doi: 10.1097/HJH.0b013e32833b49fe.
We and other investigators previously reported that isolated nocturnal hypertension on ambulatory measurement (INH) clustered with cardiovascular risk factors and was associated with intermediate target organ damage. We investigated whether INH might also predict hard cardiovascular endpoints.
We monitored blood pressure (BP) throughout the day and followed health outcomes in 8711 individuals randomly recruited from 10 populations (mean age 54.8 years, 47.0% women). Of these, 577 untreated individuals had INH (daytime BP <135/85 mmHg and night-time BP ≥120/70 mmHg) and 994 untreated individuals had isolated daytime hypertension on ambulatory measurement (IDH; daytime BP ≥135/85 mmHg and night-time BP <120/70 mmHg). During follow-up (median 10.7 years), 1284 deaths (501 cardiovascular) occurred and 1109 participants experienced a fatal or nonfatal cardiovascular event. In multivariable-adjusted analyses, compared with normotension (n = 3837), INH was associated with a higher risk of total mortality (hazard ratio 1.29, P = 0.045) and all cardiovascular events (hazard ratio 1.38, P = 0.037). IDH was associated with increases in all cardiovascular events (hazard ratio 1.46, P = 0.0019) and cardiac endpoints (hazard ratio 1.53, P = 0.0061). Of 577 patients with INH, 457 were normotensive (<140/90 mmHg) on office BP measurement. Hazard ratios associated with INH with additional adjustment for office BP were 1.31 (P = 0.039) and 1.38 (P = 0.044) for total mortality and all cardiovascular events, respectively. After exclusion of patients with office hypertension, these hazard ratios were 1.17 (P = 0.31) and 1.48 (P = 0.034).
INH predicts cardiovascular outcome in patients who are normotensive on office or on ambulatory daytime BP measurement.
我们和其他研究人员之前报道过，动态血压监测中孤立的夜间高血压（INH）与心血管危险因素聚集有关，并与中间靶器官损害相关。我们研究了 INH 是否也可以预测严重的心血管终点事件。
我们在 8711 名随机招募自 10 个人群的个体中监测了全天的血压（BP）并随访了健康结局（平均年龄 54.8 岁，47.0%为女性）。其中，577 名未经治疗的个体有 INH（日间 BP<135/85mmHg，夜间 BP≥120/70mmHg），994 名未经治疗的个体有孤立的日间动态血压升高（IDH；日间 BP≥135/85mmHg，夜间 BP<120/70mmHg）。在随访期间（中位时间 10.7 年），有 1284 人死亡（501 例心血管疾病），1109 名参与者发生了致命或非致命的心血管事件。在多变量调整分析中，与正常血压（n=3837）相比，INH 与总死亡率（危险比 1.29，P=0.045）和所有心血管事件（危险比 1.38，P=0.037）的风险增加相关。IDH 与所有心血管事件（危险比 1.46，P=0.0019）和心脏终点事件（危险比 1.53，P=0.0061）的风险增加相关。在 577 名 INH 患者中，457 名在诊室 BP 测量时血压正常（<140/90mmHg）。与 INH 相关的危险比在额外调整诊室 BP 后分别为 1.31（P=0.039）和 1.38（P=0.044），分别用于总死亡率和所有心血管事件。排除诊室高血压患者后，这些危险比分别为 1.17（P=0.31）和 1.48（P=0.034）。
在诊室或日间动态血压测量时血压正常的患者中，INH 可预测心血管结局。
